CN1250172C - Fastener holding assembly and anterior cervical plating system having same - Google Patents

Fastener holding assembly and anterior cervical plating system having same Download PDF

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Publication number
CN1250172C
CN1250172C CNB2004100033213A CN200410003321A CN1250172C CN 1250172 C CN1250172 C CN 1250172C CN B2004100033213 A CNB2004100033213 A CN B2004100033213A CN 200410003321 A CN200410003321 A CN 200410003321A CN 1250172 C CN1250172 C CN 1250172C
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CN
China
Prior art keywords
flat board
aperture
perforates
osteosynthesis
dull
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CNB2004100033213A
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Chinese (zh)
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CN1518960A (en
Inventor
D·A·尼德哈姆
J·W·波伊内尔
H·N·赫尔科维茨
T·A·兹德布利克
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Warsaw Orthopedic Inc
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SDGI Holdings Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
    • A61B17/8042—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers the additional component being a cover over the screw head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7059—Cortical plates
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
    • A61B17/8014—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones the extension or compression force being caused by interaction of the plate hole and the screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
    • A61B17/8019—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones where the means are a separate tool rather than being part of the plate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/808—Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8866—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators

Abstract

The present invention is directed to a system for anterior fixation of the spine that utilizes an elongated fixation plate. The plating system stabilizes the spine and promotes fusion and incorporation of a graft or implant in a portion of the spinal column. In one aspect of the invention, the fixation plate has a first end with a pair of holes. Bone screws extend through the holes to rigidly secure the plate to a first vertebra. The second end of the plate is provided with a pair of slots through which bone screws extend for engagement with a second vertebra. The screws extending through the slots are translatable in the slot to maintain compression of the spinal column portion. The plating system includes a retainer assembly that prevents screw back out. Methods and instruments relating to the plating system are also described.

Description

Securing member keeps assembly and has the bone fixation systems of this assembly
The application is dividing an application of application number is 00814342.0, the applying date is on October 11st, 2000 patent application.
Invention field
The present invention relates generally to be used for the apparatus of spinal column and the field of system, particularly be used for treating the apparatus and the system of the various pathological changes of cervical spine.
Technical background
As the structure of any bone, spinal column will stand to jeopardize the various pathological changes of its carrying and bearing value.These pathological changes of spinal column comprise the influence of (for example) degenerative disease, tumor and the fracture and the dislocation that are attributable to the physics wound.Spinal surgeons has been devoted to use in the wide region of surgical technic various apparatuses to solve these problems.Use elongated stiffener plate to help the stable and fixing of bottom spinal column, particularly chest and lumbar spinal column.These identical fracture empiecement technology have been found to be accepted by the surgeon to a certain extent, particularly are used for treating cervical spine.
Cervical spine can be from the front or the back approaching, this depends on the spinal disease or the pathological changes of being treated.Edit Howard An and Jerome Cotler doctor, name be called the surgery of having described many well-known cervical spines in the publication of " spinal instrumentation " throw according to and integration technology.This book has also been described the apparatus that has developed in recent years, be used for cervical spine.Thereby fracture empiecement system is considered to providing internal instrument to obtain from being remarkable aspect the fusion of the approaching cervical spine in front.
In the evolution of cervical region fracture empiecement system, particularly approaching from the front, various need being considered.For example, this system should provide strong mechanical fixation, thereby the part of each vertebra of may command is mobile.This system also should be able to stand axial load, and the seriality of each row of three row spinal columns.This system also should be able to maintain the stress level under the fatigue limit of plate material, surpass simultaneously anatomical structure or with the intensity of the vertebra of fracture empiecement system engagement.The thickness of this system should be little, so that reduce its protruding degree, particularly in the less space of cervical spine.In addition, be used for the screw that flat board is connected on the vertebra must can not relaxed or withdraw from from flat board in all time.
Though fracture empiecement system should satisfy some mechanical requirement, this system also should satisfy on some anatomy and consideration surgery.For example, the cervical region fracture empiecement system degree that the invasion to patient should be minimized, and reduce to around the wound of soft tissue.This is particular importance in the operating process that relates to cervical spine because complication may be have very much destructive, such as the injury brain stem, spinal cord or spinal column tremulous pulse.Also find optimum fracture empiecement system's permission more than one screw of placement on each vertebra of equipping with apparatus.In addition, this system should be designed to contact with vertebra highly stablely.
Many spinal fracture empiecements system is developed in some demand side of relevant spinal fixation system at recent two decades.Yet, even the fracture empiecement system design of more refined is arranged, still system is existed a demand, the demand at this system is promptly proposed effectively.
The requirement that also has to fracture empiecement system is, proposes to be designed to obtain the operation of the fusion of cervical spine.At implantation graft or implant, to keep disk space and/or to replace preferably increasing the fusion in spinal column of graft and implant and the speed of merging under one or more ill basivertebral situation.It is a kind of that to allow the preload of graft or implant and/or after this fracture empiecement system of continual load is provided be preferable.
Though fracture empiecement system of the prior art, that relate to cervical region fracture empiecement system is progressive on correct direction, but still further improved needs are arranged.Wherein, the present invention is exactly in order to satisfy these demands.
Summary of the invention
The invention provides a kind of system, it utilizes elongated fixed flat planar from the front spinal fixation.According to one aspect of the present invention, this fracture empiecement system promotes the graft in spine portion or the fusion and the merging of implant.This fracture empiecement system provides the continuous load of the implant between graft or body.On the other hand, this fracture empiecement system allows a compressive load to be applied to spine portion.This preload and continuous load have been avoided shielding stress, and allow the graft in spine portion or the fusion and the merging of implant.
According to one aspect of the present invention, fixed flat planar has first end, on first end pair of holes is arranged.Fastening element for osteosynthesis extends through this hole, and firmly flat board is fixed on first vertebra.On the second dull and stereotyped end a pair of elongated hole is set, fastening element for osteosynthesis is by this elongated hole and the engagement of second vertebra.The fastening element for osteosynthesis that extends through elongated hole can move in elongated hole, allows the fixing and compression of relative first vertebra of second vertebra.In a preferred embodiment, fracture empiecement system comprises that one keeps assembly, withdraws to prevent securing member.
According to another aspect of the present invention, provide a kind of bone fixation systems that is used for spine portion.This bone fixation systems comprises a flat board, and this flat board has a central axis, a length between first end and second end, and top surface and basal surface.Dull and stereotyped a plurality of first perforates of formation and a plurality of second perforate between top surface and basal surface.At least one of a plurality of first perforates is positioned near the first dull and stereotyped end, and forms the circular hole that runs through dull and stereotyped.At least one of a plurality of second perforates is positioned near the second dull and stereotyped end, and forms the slotted eye of first length with first width and close basal surface.A plurality of fastening element for osteosynthesis extend through first and second perforates.Each fastening element for osteosynthesis has threaded rod and enlarged head portion.This securing member have the 3rd diameter, columniform part basically, it intersects with flat board in first perforate, like this, inserts the securing member of first perforate and has set dull and stereotyped relatively constant bearing.The head that inserts the described fastening element for osteosynthesis in second hole can move along the length of second perforate, so that keep the compression of spine portion.
According to another aspect of the present invention, provide a kind of bone fixation systems that is used for spine portion.This bone fixation systems comprises a flat board, and this flat board has along the length of the central axis that extends between first end and second end.Flat board has a top surface and a basal surface, and forms a plurality of first and second perforates between two surfaces.At least one pair of of first perforate is positioned near first end, and first perforate forms the circular hole with first diameter.At least one pair of of second perforate is positioned near second end, and second perforate formation one has the elongated hole of first width and first length.A plurality of fastening element for osteosynthesis with elongated threaded rod and enlarged head portion are provided.Fastening element for osteosynthesis extends through first and second holes from top surface.One keeps assembly that fastening element for osteosynthesis is remained in first and second perforates.In a kind of form, keep assembly to comprise a pad, it has corresponding with the length of flat board basically length.
According to another aspect of the present invention, provide a bone fixation systems that is used in spine portion.This system comprises four fastening element for osteosynthesis, and they have enlarged head portion and threaded rod.One elongated flat board has the length of extending between first end and second end, its size is across between at least two vertebras.Flat board is formed with near pair of holes first end and near a pair of elongated hole second end.The shape of each hole and elongated hole can be admitted a corresponding fastening element for osteosynthesis, and fastening element for osteosynthesis is fixed on flat board on the vertebra.Fastening element for osteosynthesis extends through pair of holes, and flat board is fixed on first vertebra.Fastening element for osteosynthesis extends through a pair of elongated hole flat board is fixed on second vertebra.Fastening element for osteosynthesis can move axially in elongated hole, so that keep the compression to spine portion.
According to another aspect of the present invention, provide a kind of bone fixation systems that is used for spine portion.This system comprises six fastening element for osteosynthesis, and they respectively have enlarged head portion and threaded rod.The one elongated flat board that extends between first end and second end has the length that can cross at least three vertebras on the size.The pair of holes of dull and stereotyped formation one on first vertebra, a pair of elongated hole on second vertebra, and a pair of intermediate elongated hole on the 3rd vertebra between first vertebra and second vertebra.These holes and elongated hole can admit the threaded rod of fastening element for osteosynthesis to pass through in shape.Fastening element for osteosynthesis extends through pair of holes, and flat board is fixed on first vertebra.Fastening element for osteosynthesis extends through elongated hole, and flat board is fixed on second vertebra.Fastening element for osteosynthesis can move axially in elongated hole, so that keep the compression to spine portion.The surgeon randomly puts into fastening element for osteosynthesis in the intermediate elongated hole, makes dull and stereotyped and the 3rd vertebra fixation.
According to another aspect of the present invention, a kind of maintenance assembly that is used for elongated flat board is provided, flat board extends between at least two vertebras.This maintenance assembly comprises a pad, and pad has at least one tapered openings.By a lock fastener being screwed in the tapered openings, pad can a latched position and a non-locked position between move.
According to another aspect of the present invention, a kind of maintenance assembly that is used for elongated flat board is provided, this flat board extends between at least two vertebras.This flat board is formed with a plurality of perforates for the fastening element for osteosynthesis insertion, so that flat board is fixed on two vertebras at least.This flat board also be included on the flat board, be positioned near first fastener hole at least one perforate on first vertebra, and on the flat board, be positioned near second fastener hole at least one perforate on second vertebra.Keep assembly to comprise a pad, it forms first aperture near at least one perforate on first vertebra at least, and forms second aperture near at least one perforate on second vertebra.The lock fastener of using for each aperture on the pad has the elongated stem that extends through aperture, with the fastener hole engagement on the flat board.Pad can move between the primary importance and the second position, and in primary importance, fastening element for osteosynthesis can insert at least one perforate; In the second position, pad has a surface, this surface contacts with extending through the head that is positioned at fastening element for osteosynthesis above first vertebra, at least one perforate, and with to extend through the head that is positioned at fastening element for osteosynthesis above second vertebra, at least one perforate overlapping.
According to another aspect of the present invention, provide a kind of maintenance assembly that is used for elongated flat board.Flat board extends between at least two vertebras, and forms a plurality of perforates for the fastening element for osteosynthesis insertion, so that flat board is fixed on two vertebras at least.Flat board comprises at least one first fastener hole.Keep assembly to comprise a pad, pad is formed with first aperture at least, and first aperture is positioned on the position corresponding with at least one fastener hole.Lock screw extends through first aperture, and have with flat board on the elongated shaft of fastener hole engagement.Pad can move along the central axis between the primary importance and the second position, and in primary importance, at least two fastening element for osteosynthesis insert perforate and the engagement of first and second vertebras; In the second position, the surface of pad contacts with the head of the fastening element for osteosynthesis that meshes with first vertebra at least.
According to another aspect of the present invention, provide a kind of method that applies compressive load to a plurality of vertebras that comprise first vertebra and second vertebra at least.This method comprises: (a) provide one to have the template of a guiding surface and a recess; (b) with Template Location on second vertebra, and guiding surface is positioned on the body of second vertebra template recess on the soleplate of second vertebra; (c) pin recess that is inserted through template enters the body of second vertebra; (d) take template away; (e) sleeve pipe is placed on the pin; (f) provide a flat board, this flat board has the length of extending between first end and second end, and flat board is included in recess and a plurality of perforate that runs through of second end; (g) flat board is placed on the spine portion, and sleeve pipe is positioned in the dull and stereotyped recess; (h) be fixed on first vertebra with extending through at the fastening element for osteosynthesis of the perforate on first vertebra first end with flat board; (i) take sleeve pipe away from pin, thereby between the recess of pin and flat board, form a gap; (j) connect pin peace plate with a tool of compression; And (k) utilize tool of compression to apply a compressive load and give spine portion, contact with recess until pin.In an embodiment, flat board comprises hole that is positioned on first vertebra and the elongated hole that is positioned on second vertebra.In another embodiment, this method also comprises with one and keeps assembly that fastening element for osteosynthesis is remained on step in the flat board.
According to another aspect of the present invention.A kind of method of keeping the compression of spine portion is provided.This method comprises: a flat board (a) is provided, this flat board has the length between first end and second end, its size can be crossed over two vertebras at least, and this flat board has pair of holes at the first end place that is positioned at above first vertebra, has a pair of elongated hole at the second end place that is positioned at above second vertebra; (b) be fixed on first vertebra with first end of the fastening element for osteosynthesis that extends through pair of holes flat board; (c) be fixed on second vertebra with second end of the fastening element for osteosynthesis that extends through a pair of elongated hole flat board; And (d) move fastening element for osteosynthesis in elongated hole, so that the spinal fixation part.In an embodiment, this method also comprises with one and keeps assembly that fastening element for osteosynthesis is remained in the flat board.
These and other form, embodiment, aspect, feature and purpose of the present invention will be seen clearly from following introduction.
Description of drawings
Fig. 1 is the top perspective view according to fracture empiecement system before of the present invention;
Fig. 2 is the top perspective view of the preceding fracture empiecement system among Fig. 1, some of them bone screw locks in place;
Fig. 3 is the top perspective view of the preceding fracture empiecement system among Fig. 1, and the some of them bone screw moves in the elongated hole of flat board;
Fig. 4 (a)-4 (f) is the vertical view with fixed flat planar of the present invention of different size and structure;
Fig. 5 (a)-5 (f) is the vertical view that has corresponding to the pad of the present invention of the size of the flat board among Fig. 4 (a)-4 (f) and structure;
Fig. 6 is the side view according to the bone screw of one aspect of the present invention;
Fig. 7 is the side view according to the present invention's lock fastener on the other hand;
Fig. 8 (a)-8 (k) is each view and the cutaway view according to pad of the present invention;
Fig. 9 is the vertical view of first end of fixed flat planar of the present invention;
Figure 10 is the cutaway view along the 10-10 line among Fig. 9;
Figure 11 is the end-view of the flat board among Fig. 9;
Figure 12 is the vertical view of second end of fixed flat planar of the present invention;
Figure 13 is the cutaway view along the 13-13 line among Figure 12;
Figure 14 is the cutaway view along the 14-14 line among Figure 12;
Figure 15 is the vertical view of the mid portion of fixed flat planar of the present invention;
Figure 16 is the cutaway view along the 16-16 line among Figure 15;
Figure 17 is the cutaway view along the amplification of the 17-17 line among Figure 15;
Figure 18 is the cutaway view along the amplification of the 18-18 line among Figure 15;
Figure 19 a is the partial sectional view of preceding fracture empiecement assembly of the present invention, and wherein, screw passes the hole on the first dull and stereotyped end and is engaged in the vertebra;
Figure 19 b is the partial sectional view of preceding fracture empiecement assembly of the present invention, and wherein, screw passes dull and stereotyped elongated hole and is engaged in the vertebra;
Figure 20 (a)-20 (f) described according to the present invention on the other hand various apparatuses and the step of method;
Figure 21 (a)-21 (c) is each axonometric chart according to the tool of compression of another aspect of the invention;
Figure 22 (a)-22 (b) is each side view of arm of the tool of compression of an alternative embodiment.
The specific embodiment
In order to help to understand principle of the present invention, in embodiment shown in the drawings, will use label, and describe these embodiment with specific language.Yet should be understood that scope of the present invention does not limit thus.For those skilled in the art, be expected to any replacement of described device and the further application of the further improvement and the principle of the invention.
Fig. 1-3 has shown a fracture empiecement system 30, and it is used for from the front near cervical spine.The spine portion that schematically shows among Fig. 1 comprises first vertebrae V 1, second vertebrae V 2, and intermediate vertebra V3 and V4.Preferably, first vertebrae V 1 is the vertebra below or the bottom in the spine portion, and second vertebrae V 2 is the vertebras top or the top in the spine portion.Yet, can think that also first vertebra is a superior vertebra, and second vertebra is an inferior vertebra.It will also be appreciated that as described belowly, the present invention also can be applicable to comprise the spine portion of the vertebra in from two to the six vertebra scopes in number.One or more implant I can put in the one or more disk space between the adjacent vertebrae as required.But implant I bone graft, fusing device or other any kind, can insert disk space with the amboceptor device that allows adjacent vertebrae to merge.
According to the present invention, fracture empiecement system 30 comprises an elongated flat board 31, but it has a plurality of perforation and a plurality of with the bone engaged with fastener in the patchhole of bone screw 50 forms demonstration.In a kind of preferable form, each bone engaged with fastener is a bone screw.Dull and stereotyped 31 have a longitudinal axes L, and it extends on the heart line therein along the length of flat board.Bone engaged with fastener or bone screw 50 are fixed on dull and stereotyped 31 by the maintenance assembly 33 that is provided with along axis L.Elongated dull and stereotyped 31 hole is included near the pair of holes 34 on first tuberosity 36 of dull and stereotyped 31 first ends.First tuberosity 36 is positioned at above first vertebrae V 1.Dull and stereotyped 31 also are included near a pair of elongated hole 35 on second tuberosity 37 of dull and stereotyped 31 second ends.Second tuberosity 37 is positioned at above second vertebrae V 2.31 li of the flat boards of some shape, the length along dull and stereotyped 31, between first tuberosity 36 and second tuberosity 37, also have some in the middle of tuberositys 38.Tuberosity 38 comprises a pair of intermediate elongated hole 32 that is positioned at above one of corresponding intermediate vertebra V3 and V4 in the middle of each.Fracture empiecement system 30 can use the biocompatible material manufacture of any kind.
Preferably, hole 34 is paired, a side that is positioned at longitudinal axes L in the pair of holes, and another in the pair of holes is positioned at the opposite side of longitudinal axes L.Elongated hole 32 and 35 is arranged in similarly paired mode.Preferably, paired hole 34 is identical on shape and size, and is arranged on symmetrically near the axis L.Pairs of elongated hole 35 also is identical on shape and size, and is arranged on symmetrically near the axis L.Pairs of elongated hole 32 on middle tuberosity 38 also is identical on shape and size, and be arranged on symmetrically axis L near.The dull and stereotyped recess that also is included between each tuberosity 36,37 and 38 is so that reduce dull and stereotyped overall dimensions.In addition, the recess between each tuberosity provides a zone of reducing material, so that the extra bending to flat board that allows the surgeon may need when anatomy of spine.Dull and stereotyped 31 have the surgeon according to the selected length of the tuberosity 36,37 that matches with patient's vertebra and (if desired) tuberosity 38.
Dull and stereotyped 31 preferably comprise rounded upper surface 41, and when dull and stereotyped and spinal column engagement, this upper surface contacts with the soft tissue that surrounds spinal column.Circular surface 41 has reduced the degree of the damage that may be subjected to of the soft tissue that surrounds.Dull and stereotyped 31 basal surface 42 is preferably made with the vertebral body of spinal column and is contacted.In an embodiment, at least a portion of basal surface 42 can be along the length of flat board by veining, so that improve it in epicentral grip.
Hole 34 comprises the recess 45 near dull and stereotyped top surface, so that allow the bone engaged with fastener, imbed dull and stereotyped 31 li such as the head of bone screw 50.Similarly, intermediate elongated hole 32 comprise around each elongated hole 32, near the recess 46 of dull and stereotyped top surface, and elongated hole 35 comprise around each elongated hole 35, near the recess 47 of dull and stereotyped top surface.Preferably, elongated hole 35 comprises inclined-plane 60, and is as described below, and it allows when screw 50 inserts at second end, 43 places of elongated hole 35 the dynamic compression load to be applied on the spine portion.The head that recess 46 and 47 also allows screw 50 is imbedded dull and stereotyped 31 li when inserting corresponding elongated hole 32 and 35 li.One groove 39 extends along dull and stereotyped 31 axis L, and intersects along length and each recess 45,46 and 47 of groove 39.Dull and stereotyped 31 comprise a recess 40 in the end of second tuberosity 37, it is circle preferably, and having with axis L is radius centered R4 (Figure 12).
Keep assembly 33 to comprise a pad 90, it has the length that corresponds essentially to dull and stereotyped 31 length.Be formed with a plurality of apertures 91 on the pad 90.Each aperture 91 is arranged on respectively on the body part 93,94 and 95 corresponding with vertebra tuberosity 36,37 and 38.Coupling part 98 is extended between body part 93,94 and 95 and is connected with them.Each aperture 91 has at close pad 90 top surface places around the counterbore 92 that extends.Will introduce in detail as following, counterbore 92 narrows down to second width at aperture 91 second end places gradually from first width at aperture 91 first ends, and first width is greater than second width.The lock fastener that shows with screw 85 shapes is orientable, and they respectively pass a corresponding aperture 91, with fastener hole 70 (seeing Fig. 4 (a)-4 (the f)) engagement on dull and stereotyped 31, thereby connects pad 90 and dull and stereotyped 31.
Therefore, maintenance assembly 33 remains in the screw 50 in the vertebral body on each instrumentation level.Pad 90 is from so that the latched position (Fig. 2) of the unlocked position (Fig. 1) that bone screw inserts after screw inserts moves, so that contact with the head of 34 li in the hole bone screw, and overlaps on the head of bone screw of elongated hole 32 and 35 li.Preferably, pad 90 with at the head of elongated hole 32 with 35 li bone screw does not contact, thereby allows bone screw to move in elongated hole.When bone screw withdraws from enough amounts from its position and contacts with pad 90, can prevent withdrawing from the bone screw of elongated hole 32 and 35 li.Preferably, pad 90 almost completely is positioned at 39 li of dull and stereotyped 31 grooves, so that the overall height of structure is reduced to a minimum.
As shown in Figure 1, keep assembly 33 to be in unlocked state because of second end that screw 85 is positioned at aperture 91.Under unlocked state, the body part 93,94 and 95 of pad 90 is underlapped on the part of hole 34 and elongated hole 32 and 35, thereby can insert bone screw 50 therein.The narrow 98 of pad 90 allows bone screw 50 by hole 34 and elongated hole 35, so that flat board 31 is fixed on vertebrae V 1 and the V2.If desired, the surgeon also can put into bone screw 32 li in intermediate elongated hole, so that flat board 31 is fixed on vertebrae V 3 and the V4.Dull and stereotyped 31 with bone screw 50 preferably in the hole 34 li be connected, thereby obtain rigidly fixing of dull and stereotyped 31 and first vertebrae V 1.Elongated hole 35 is positioned at second vertebrae V, 2 tops, and comprises second end 43 and first end 44.As shown in Figure 1, screw 50 at first inserts second end 43 of elongated hole 35, allows the screw 50 35 li of elongated hole move to first end 44 from second end 43 then.For the sake of clarity, only drawn a screw 50 35 li of elongated hole; Yet, it is contemplated that, all insert bone screw for 35 li two elongated hole.The bone screw 50 that inserts 32 li in intermediate elongated hole also can move (Figure 15) to first end 49 from second end 48 of elongated hole 32.
In case screw 50 is put into hole 34 and elongated hole 32 and 35, keep the pad 90 of assembly 33 to be movable to latched position shown in Figure 2.In this latched position, the body part 93,94 of pad 90 and 95 heads with the screw 50 that inserts remain on hole 34 and elongated hole 32 and 35 li, prevent that screw from withdrawing from from dull and stereotyped 31.In order to keep assembly 33 to move to latched position, lock screw 85 screws in 70 li of the fastener hole of dull and stereotyped 31 correspondence.The downward screw-in of lock screw 85 makes the taper counterbore 92 on the pad 90 slide along the head of lock screw 85, until first end in contact of lock screw 85 with aperture 91.Pad 90 is moved to latched position along axis L, and in this position, pad 90 remains on dull and stereotyped 31 li with bone screw 50.
Bone screw 50 is allowed in elongated hole 35 and intermediate elongated hole 32 li and moves, and moves to first end of elongated hole from second end of elongated hole, and simultaneously, 33 remain on dull and stereotyped 31 li with bone screw 50 in the middle of keeping, and prevent that screw from withdrawing from.As shown in Figure 3, the screw that is positioned at 35 li of elongated hole moves to first end 44 from second end 43.Moving of screw 50 is restricted owing to screw 50 contacts with first end 44.Amount of movement also can be controlled for 32 li by bone screw being placed on the intermediate elongated hole.Like this, the amount of movement of spine portion can be restricted by the length of elongated hole 32 and 35.
Referring now to Fig. 4 (a)-4 (f) and Fig. 5 (a)-5 (f),, they have shown elongated dull and stereotyped 31 and some embodiment of pad 90.Should be understood that according to the empiecement system 30 of fracturing the preceding of the present invention and can easily be fixed on some vertebras by improving dull and stereotyped 31 the length and the quantity and the structure in hole 34, second elongated hole 35 and intermediate elongated hole 32.Pairs of elongated hole 32 on each vertebra and 35 and the 34 li bottom lines in paired hole at least two bone screws 50 are provided so that with the engagement of each vertebra.In each vertebral body, place two or more screws and can improve stability of structure.One object of the present invention is not only provides a plurality of screws in each vertebral body, and provides bone screw is remained on device on dull and stereotyped 31, gets loose so that prevent screw.The present invention also prepares to provide the various specific embodiments of flat board, and their length is in 19mm to 110mm scope, and the about 17.8mm of overall width.Yet the length and the width of other dull and stereotyped size also can be considered.
Flat board 31 among Fig. 1-3 is crossed over four vertebras dimensionally, comprises first tuberosity 36, second tuberosity 37 and two middle tuberositys 38.In Fig. 4 (a) and 5 (a), dull and stereotyped 31a has at hole 34a on the first tuberosity 36a and the hole 34a on the second tuberosity 37a.Dull and stereotyped 31a goes up pad 90a is installed, and pad 90a is positioned in the groove 39a, and removable and remain in the 34a of hole with regard to bone screw.In this embodiment, dull and stereotyped 31a provides rigidly fixing on each vertebra.Fig. 4 (b) and Fig. 5 (b) have shown a kind of improvement of dull and stereotyped 31.Replaced by the elongated hole 35b on the second tuberosity 37b in the hole on the second vertebra tuberosity.Pad 90b is positioned in the groove 39b, and removable and bone screw is remained in hole 34b and the elongated hole 35b.
Dull and stereotyped 31c and pad 90c among Fig. 4 (c) and Fig. 5 (c) provide apparatus at two vertebra places equally.Dull and stereotyped 30c has the recess between two tuberosity 36c and 37c.Pad 90c is positioned in the groove 39c, and removable and bone screw is remained in hole 34c and the elongated hole 35c.Should be understood that the flat board among Fig. 4 (a)-4 (c) crosses over two vertebras, and preferably be not included in the recess 40 at the dull and stereotyped second end place, as having on across the flat board of three or more vertebras in size.
Dull and stereotyped 31d and pad 90d among Fig. 4 (d) and 5 (d) provide apparatus at three vertebra places.Dull and stereotyped 31d has the first vertebra tuberosity 36d, the second vertebra tuberosity 37d and middle tuberosity 38d.Pad 90d is positioned in the groove 39d, and removable and bone screw is remained in hole 34d and elongated hole 32d and the 35d.Dull and stereotyped 31e and pad 90e among Fig. 4 (e) and Fig. 5 (e) provide apparatus at five vertebra places.Dull and stereotyped 31e has the first vertebra tuberosity 36e, the second vertebra tuberosity 37e and three middle tuberosity 38e.Pad 90e is positioned in the groove 39e, and removable and bone screw is remained in hole 34e and elongated hole 32e and the 35e.Dull and stereotyped 31f and pad 90f among Fig. 4 (f) and 5 (f) provide apparatus at six vertebra places.Dull and stereotyped 31f has the first vertebra tuberosity 36f, the second vertebra tuberosity 37f and four middle tuberosity 38f.Pad 90f is positioned in the groove 39f, and removable and bone screw is remained in hole 34f and elongated hole 32f and the 35f.
Referring now to Fig. 6,, it has at length shown engaged with fastener or bone screw 50.Bone screw 50 preferably is made into and can meshes with cervical spine, and it comprises threaded rod 51, and each threaded rod 51 is made into and can meshes with basivertebral spongy bone.Can provide tapping screw thread on the threaded rod, though expect that also this screw thread may need pre-light to hole and tapping on vertebral body, so that screw 50 inserts.Preferably, the screw thread on the threaded rod 51 forms constant outside diameter d 2 along the length of bar.In addition, preferably, threaded rod 51 has the diminishing root diameter of length part along bar.
Mid portion 52 extends between the bar 51 of screw 50 and head 54.Screw thread on bar 51 extends into mid portion 52 by run-out(of thread) 53.According to the processing technique of standard, column part 52 comprises does not have a bit of of screw thread.Hole 34 that this section column part 52 and bone screw 50 extend through or elongated hole 32 and 35 slab-thickness in conjunction with or contact.This segment has outside diameter d 1.The head 54 of screw 50 comprises a tool receptacle 55, so that admit a turn instrument.In a specific embodiment, tool receptacle 44 is hex-shaped recess, but for those skilled in the art, also can be the turn groove of other type.The top surface that head 54 comprises is a butt or flat, have the d4 diameter.One spherical surface 57 extends to shoulder 59 from column part 52.Shoulder 59 has diameter d 5.One inclined surface 58 extends between shoulder 59 and butt top surface 56.Inclined surface 58 relative top surfaces 56 are A at angle 1
On the expection screw 50 bar 51 with the length that changes from about 10mm to about 24mm can be set.In a specific embodiment of screw 50, screw thread has the diameter d 2 of about 4.5mm.In another specific embodiment, diameter d 2 is 4.0mm approximately.In these two specific embodiments, column part 52 has the diameter d 1 of about 4.05mm.Column part 52 has and highly is the unthreaded portion of h1, and it is to determine by the standard-processing techinque that is formed on the run-out(of thread) between bar and the screw head.The height h1 of column part 52 and the above-mentioned size of diameter d 1 are for being slidingly matched between the screw 50 that obtains to pass hole 34 or elongated hole 32 and 35 and dull and stereotyped 31.Head 54 have the height h2, in the outside diameter d 5 at shoulder 59 places, in the diameter d 4 at top surface 56 places and the included angle A of inclined surface 54 1, like this, head 54 enters corresponding elongated hole 32 and 35 or 34 li in hole, and is positioned under the dull and stereotyped top surface.Though in this specific embodiment, mention concrete size, should be understood that the present invention also can have the screw 50 of other size and structure.It will also be appreciated that the bone screw that is used for fixing flat board 31 can respectively have different length and diameter, and do not need strict corresponding with other synthetism engaged with fastener that is used for this structure.
Fig. 7 has shown the details of lock screw 85.Lock screw 85 comprises having machined threads.In a specific embodiment, lock screw 85 ends at a sharp point 88, and when lock screw was fixed on 70 li in screw threads for fastening hole, it can penetrate vertebral body.Head 87 comprises taper seat 89, and its structure can cooperate with the aperture on the pad 90.Head 87 also comprises a tool receptacle 87a, so that admit a turn instrument.
Other details and the embodiment of the pad 90 in the maintenance assembly 33 can be referring to Fig. 8 (a)-8 (k).Pad 90 comprises second body part 95, first body part 93 and (if desired) intermediate body member part 94.Coupling part 98 is extended between each body part 93,94 and 95 and is connected with them.Pad 90 has top surface 100a and basal surface 100b.Each body part 94 and 95 forms an aperture 91 that extends between top surface 100a and basal surface 100b.Aperture 91 has near the taper counterbore part 92 top surface 100b.Aperture 91 allows the bar 86 of lock screw 85 to pass through, and counterbore 92 is preferably made with conical surface 89 and cooperated, and lock screw 85 is placed in each position along the length 91 of aperture.Preferably, counterbore part 92 tilts to basal surface 100b from second end, 97 to first ends 96.The tapered feature of working in coordination between lock screw 85 and the aperture 91 provides relative to dull and stereotyped 31 moving automatically for when lock screw 85 is screwed into 70 li of dull and stereotyped 31 fastener holes pad 90.
Body part 93,94 and 95 has width W 1, and it is greater than the width W 2 of coupling part 98. Body part 93,94 and 95 width W 1 and length are made into to allow the recess 46 and 47 of the recess 45 in body part and hole 34 and elongated hole 32 and 35 overlapping.When pad 90 was positioned at 39 li of grooves and is positioned at the latched position of Fig. 2, body part 93,94 and 95 kept the head of bone screw to extend through dull and stereotyped 31 hole and elongated hole.When pad 90 was positioned at unlocked position shown in Figure 1, the width W 2 of coupling part 98 and length were made into to allow screw insertion hole 34 and elongated hole 32 and 35 li.
In Fig. 8 (a) and 8 (b) lining, shown second body part 95 of pad 90.Aperture 91 has counterbore part 92, and it dwindles gradually along the length of aperture.Aperture 91 has width W 3 at the basal surface 100b place of pad 90.Counterbore part 92 has the width that changes along the length of aperture 91, and this width is greater than width W 3.Counterbore part 92 has radius R 1 at second end, 97 places of top surface 100a, and 96 places have radius R 2 at first end.Preferably, R1 is less than R2, and the width of counterbore part 92 increases to first end 96 gradually from second end 97.Aperture 91 has the chord length S1 that extends between the center of the center of radius R 1 and radius R 2.Body part 95 also is included in the transition portion 99 that extends between coupling part 98 and the body part 95.
Intermediate body member part 94 among Fig. 8 (c) and 8 (d) is similar to second body part 95 among Fig. 8 (a) and 8 (b) aspect a lot, also comprise the aperture 91 with taper counterbore part 92.Yet intermediate body member part 94 has the coupling part 98 of extending from both direction.The second transition portion 98a extends between second coupling part 98 and body part 94.Body part 94 has the chord length S1 between the center of the center of radius R 1 and radius R 2.
The taper counterbore 92 of aperture provides automatic locomotivity for pad 90.This is because when lock screw 85 screwed in screwed hole 70, pad 90 moved relative to dull and stereotyped 31.The cam conical surface 89 of screw 85 moves down along the tapering part of the wall of the counterbore part 92 of aperture 91.
Fig. 8 (e) and 8 (f) have shown first body part 93.First body part 93 also is similar to second body part 95.Yet, in an embodiment, first body part 93 comprise an aperture 91 ', aperture 91 ' have counterbore part 92 ', it is not to dwindle gradually along its length, automatic locomotivity is provided for pad 90 so that resemble the counterbore part 92 in body part 94 and 95.On the contrary, pad 90 as mentioned above like that relative to dull and stereotyped 31 move after, lock screw 85 will still be positioned at first end 96 ' locate, and can screw in 70 li in hole then, thereby be positioned at counterbore part 92 ' lining.In addition, an also available hands of surgeon or an instrument make pad slide into its shift position, and the counterbore 92 ' lining by lock screw being put into first end 96 ' locate and pad is locked in its shift position.Counterbore 92 ' have so that place lock screw 85, provides a reference to the surgeon, so that determine that pad 90 has moved to its latched position at second end 96 ' locate allocation really.However, it should be understood that also can imagine the body part 94 and 95 that is similar to shown in Fig. 1-3 is provided at body part 93 places.
Referring now to Fig. 8 (g),, it provides the cutaway view by the pad 90 of the aperture 91 of body part 94 and 95.Pad 90 has an outer surface 104, and when keeping assembly 33 to be positioned at its latched position, the bone screw 50 of it and elongated hole 32 and 35 li is overlapping, but does not contact with the inclined surface 58 of screw 50.Outer surface 104 extends to shoulder 103 from basal surface 100b.Shoulder 103 extends between inclined surface 104 and top surface 100a.The relative basal surface 100b of inclined surface becomes included angle A 2Pad 90 be limited between top surface 100a and the basal surface 100b thickness t 1 and from the shoulder height t 2 of basal surface 100b.Pad has the width W 7 at the aperture at basal surface 100b place.
Referring now to Fig. 8 (h),, it provide aperture 91 or 91 by body part 93 ' the cutaway view of pad 90.Pad 90 has contact surface 106, and when keeping assembly 33 to be in the lock state, contact surface 106 contacts with the inclined surface 58 of screw 50.Contact surface 106 extends to shoulder 105 from basal surface 100b.Shoulder 105 extends between contact surface 106 and top surface 100a.Contact surface 106 relative basal surface 100b form an included angle A 3, it is made into to cooperate with the inclined surface 58 of bone screw 50 and provide the surface that contacts with inclined surface 58.Pad 90 is limited to the thickness t 3 between top surface 100a and the basal surface 100b, and from the shoulder height t 4 of basal surface 100b.
In a specific embodiment of pad 90, body part has width W 1, and the coupling part has width W 2, and this is based on space between the centrage in the pairs of elongated hole of flat board and hole and dull and stereotyped integral width.The bar 86 that the width W 3 of the aperture 91 in this specific embodiment can be held lock screw 85 does not allow head 87 to pass through again.Body part 94 and 95 length are according to dull and stereotyped 31 li elongated hole 32,35 and the length between the hole 34 and change at interval.Preferably, body part 94 and 95 has the eclipsed length of whole length of enough and elongated hole 32 and 35 when keeping assembly 33 to be positioned at its latched position.Taper counterbore part 92 radius Rs 1 of aperture 91, it is transformed into radius R 2 along chord length S1.Thickness t 1 is less than thickness t 3, and shoulder height t 4 is less than shoulder height t 2.Body part 93 has the width W 8 along basal surface 100b, and it is greater than the width W 7 of body part 94 and 95.Included angle A 2Preferably less than included angle A 1The size of pad 90 is preferably arranged like this, and body part 94 contact with being placed on the screw head of elongated hole 32 with 35 li with 95, so that screw is mobile elongated hole 32 and 35 li.Body part 93 contacts with the screw head that is placed on 34 li in hole, so that further be increased in the screw 50 in 34 li in hole and the constant bearing between the flat board 31.Though mentioned the space characteristics of this specific embodiment, should be understood that pad 90 among the present invention can also have other orientation and spatial relationship.
The present invention has also imagined a kind of maintenance assembly, wherein, provides independent pad at each tuberosity place, so that screw is remained on dull and stereotyped 31 hole 34 and elongated hole 32 and 35 li.Referring now to Fig. 8 (i) and 8 (j),, provide an opening pad 195 and a perforate pad 193.Opening pad 195 is similar to the body part 95 of pad 90, and perforate pad 193 is similar to the body part 93 of pad 90, and they were all introduced in the above.Components identical has the label identical with the counter element of body part 95 and 93.Opening pad 195 and perforate pad 193 do not extend to the coupling part 98 of another pad.Perforate opening pad 195 has body part 198, and body part 198 has length S2, and when pad 195 was positioned on dull and stereotyped 31, this length S2 was corresponding with the length of adjacent elongated hole 32 and 35 dimensionally.Opening pad 195 does not extend to the coupling part 98 of another pad.The perforate pad has body part 199, and body part 199 has length S3, and when pad was positioned on dull and stereotyped 31, this length was corresponding with the length in adjacent hole 34 dimensionally.
In Fig. 8 (k), another embodiment of pad 193 and 195 is provided, they are respectively with label 193 ' and 195 ' represent.Pad 193 ' with 195 ' identical with above-mentioned pad 193 and 195, except aperture 191.Aperture 191 does not have the taper counterbore, and only has semicircle counterbore part 192 at first end, 196 places.After dull and stereotyped 31 moved, counterbore part 192 provided unique position for lock screw 85 at pad 193 ' with 195 ' by the surgeon, so that with pad 193 ' and 195 ' be locked on dull and stereotyped 31.Pad 193 ' and 195 ' have body part 198 ' and 199 ', body part has length S4, and S4 can change as above-mentioned length S2 and S3.
Referring now to Fig. 9-18,, will dull and stereotyped 31 further details be discussed by introduction to first tuberosity 36, second tuberosity 37 and middle tuberosity 38.In Fig. 9-11, shown dull and stereotyped 31 first tuberosity 36.Preferably, hole 34 relative axis L are identical with symmetric.Hole 34 comprises the recess 45 near top surface 41.Hole 34 comprises a cylindrical hole 77, and this cylindrical hole 77 has the vertical sidewall of close top surface 42.Cylindrical hole 77 extends between the basal surface 42 of recess 45 and dull and stereotyped 31, and has diameter D1.Cylindrical hole 77 has axis 72b, and it departs from an included angle A perpendicular to the dull and stereotyped 31 axis 72a that extend relatively 5, as shown in figure 10.Recess 45 has a part-spherical part 45a who limits around central axis 72b.Axis 72b and axis 72a depart from an included angle A 5Deflecting angle A 5The guiding bone screw is to the first end patchhole 34 of flat board 31.In addition, as shown in figure 11, axis 72a with respect to the axis 72c that extends along centrage perpendicular to the flat board 31 of axis L with included angle A 4Converge at below dull and stereotyped 31 the basal surface 42.Recess 45 is in groove 39 at intersection 45c and intersects.The spherical surface 57 that spherical part 45a is built in bone screw 50 cooperates, thereby allows at least a portion of head 54 to be positioned under the top surface 41 of flat board 31.
Insert for the ease of drill guide device, drill bit and bone screw 50, recess 45 also comprises an expansion 45b, and it extends to farther direction from axis 72b.In an embodiment, recess 45 comprises be parallel to wall hole 77, that extend between spherical part 45a and expansion 45b, so that the drill guide device inserts and remain on 45 li of recesses.
In a specific embodiment, spherical part 45a has a diameter, and this diameter cooperates with the diameter of the spherical surface 57 of screw 50, and is slightly larger than the diameter d 5 of bone screw 50 heads 54.The cylindrical hole 77 in hole 34 has the diameter D1 of 4.1mm, and this slightly larger in diameter is in the diameter d 1 of the mid portion 52 of screw 50.This part of screw contacts with hole 77, and is assumed to dull and stereotyped 31 constant bearing relatively.In this specific embodiment, deflecting angle A 5Be 12.6 degree approximately, with respect to the convergent angle A of axis 72c 4Be 6 degree approximately.Though mentioned the space characteristics of this specific embodiment, should be understood that the present invention can also have other size.
Referring now to Figure 12-14,, they have shown the second vertebra tuberosity 37.Vertebra tuberosity 37 comprises elongated hole 35, they preferably relatively axis L be identical with symmetric.Elongated hole 35 comprises the slotted eye 78 near dull and stereotyped 31 basal surfaces 42, and it has the vertical sidewall that extends between second end 43 and first end 44.Slotted eye 78 is at basal surface 42 with near extending between the recess 42 of top surface 42.Slotted eye 78 has width W 5 and chord length S4, and has the central axis 75b that extends by dull and stereotyped 31.Recess 47 has the spherical part 47a around central axis 75b, and central axis 75b extends around elongated hole 35.As shown in figure 13, central axis 75b departs from an included angle A of axis 75a of extending perpendicular to dull and stereotyped 31 5Deflecting angle A 5The guiding bone screw inserts elongated hole 35 towards dull and stereotyped 31 second end.Should be understood that elongated hole 35 allows bone screws with less than A 5Angle insert elongated hole 35.And bone screw 50 can be positioned at 35 li of elongated hole in any position between end 43 and 44.Yet, keep assembly 33 that bone screw 50 is inserted at second end, 43 places, this more meets clinical fixed needs.In addition, as shown in figure 14, axis 75b with respect to axis 72c with included angle A 4Converge under the basal surface 42 of flat board 31.
Spherical part 47a is made into to cooperate with the spherical surface 57 of bone screw 50, thereby allows at least a portion of head 54 to be positioned under the top surface of flat board 31.For the ease of the insertion of drill guide device, drill bit and bone screw, recess 47 also comprises an expansion 47b around spherical part 47a extension.In an embodiment, expection recess 47 comprises that one is parallel to the wall in hole 78, and this wall extends between spherical part 47a and expansion 47b, inserts and remains in the recess thereby more help the drill guide device.Recess 47 intersects at lap 47c place and groove 39, as shown in figure 14.Second end of second tuberosity 37 comprises that having with axis L is the recess 40 of radius centered R4.Here also there is not recess 40 in the expection dull and stereotyped 31, shown in Fig. 4 (a)-4 (c).
In a preferred embodiment, elongated hole 35 is included in the inclined-plane 60 that extends between the hole 78 at second end, 43 places and the expansion 47b.Inclined-plane 60 does not allow the spherical surface 57 of screw 50 to be positioned at wherein, but its orientation impels second end 43 of elongated hole 35 to separate with screw 50 when screw 50 screws in 35 li of elongated hole.The spherical part 57 of head 54 60 provides the cam effect along the inclined-plane, is positioned at 47 li of recesses until head 54 in the position that is spaced a distance with second end 43.This cam effect applies a dynamic compression and is carried on spine portion.Impose on the decrement of spine portion by the length on inclined-plane, promptly be positioned at the Position Control of 35 li of the elongated hole of recess 47 from second end 43 to screw 50.Should be understood that elongated hole 35 can not have inclined-plane 60 yet.
In a specific embodiment, spherical part 47a has the diameter that cooperates with the spherical surface 57 of screw 50, and slightly greater than the diameter d 5 of bone screw 50 heads 54.Slotted eye 78 has the width W 5 of about 4.1mm, and width W 5 is slightly larger than the diameter d 1 of the mid portion 52 of screw 50.The cylindrical part 52 of bone screw 50 contact with dull and stereotyped 31 78 li of slotted eyes, and prevents that screw 50 is laterally facing to axis 72c rotations.Chord length S4 changes according to the length of elongated hole 35, and that the length of this elongated hole 35 is dull and stereotyped 31 practical application and patient bone is needed.In this specific embodiment, deflecting angle A 5Be 12.6 degree approximately, and with respect to the convergent angle A of axis 72c 4Be 6 degree approximately.Though mentioned the space characteristics of this specific embodiment, should be understood that the present invention expects that also other size is arranged.
Referring now to Figure 15-17,, they have shown each view of middle tuberosity 38.Vertebra tuberosity 38 comprises elongated hole 32, and elongated hole 32 is identical with symmetric with respect to axis L preferably.Elongated hole 32 comprises the slotted eye 79 near the top surface 42 of flat board 31, and they have the vertical sidewall that extends between second end 48 and first end 49.Slotted eye 79 is at basal surface 42 with near extending between the recess 46 of top surface 42.Slotted eye 79 has width W 5 and chord length S5, and has the central axis 76a that extends through flat board 31.Recess 46 has the spherical part 46a that extends around elongated hole 35.As shown in figure 16, central axis 76a extends perpendicular to dull and stereotyped 31.Yet, as shown in figure 17, axis 76a with respect to axis 72c with included angle A 4Converge at below dull and stereotyped 31 the basal surface 42.Should be understood that elongated hole 32 allows bone screw 50 to insert with the various angles with respect to axis 76a.
Spherical part 46a is made into to cooperate with the spherical surface 57 of bone screw 50, thereby allows at least a portion of head 54 to be positioned under the top surface 41 of flat board 31.Insert for the ease of drill guide device, drill bit and bone screw 50, recess 46 also comprises the expansion 46b that extends around spherical part 46a.In an embodiment, a wall that is parallel to hole 79 extends between spherical part 46a and expansion 46b, inserts and remain on 46 li of recesses so that more help the drill guide device.Screw 50 can be placed on 32 li in intermediate elongated hole between end 48 and 49.Yet preferably, screw at first inserts at second end, 48 places, thereby allows the compressive load of spine portion.Recess 46 intersects at lap 46c place and groove 39, as shown in figure 17.
In a specific embodiment, spherical part 46a has the diameter that cooperates with the spherical surface 57 of screw 50 on the size, and is slightly larger than the diameter d 5 of bone screw 50 heads 54.Slotted eye 79 has the width W 5 of about 4.1mm, and this width is slightly larger than the diameter d 1 of the mid portion 52 of screw 50.79 li in the hole of the cylindrical parts 52 of bone screw 40 docks with dull and stereotyped 31, prevent that thus screw 50 from laterally facing toward the angle adjustment of axis 72c.Chord length S5 changes according to the length of elongated hole 35, and that this length is dull and stereotyped practical application and patient bone is needed.In this specific embodiment, the convergent angle A of relative axis 72c 4Be 6 degree approximately.Though mentioned the space characteristics of this specific embodiment, should be understood that the present invention expects that also other size is arranged.
Referring now to Figure 18,, it is the cross-sectional view of the flat board 31 that provides by the 18-18 line among Figure 15.Groove 39 has width W 6 at dull and stereotyped 31 top surface 41 places.Groove 39 has the basal surface 73 that extends between sloped sidewall 74.Sidewall 74 extends between the top surface 41 of the basal surface 73 of groove 39 and dull and stereotyped 31.Can expect that groove 39 has the degree of depth that is enough to hold pad 90, thereby make outstanding the minimize degree of pad on dull and stereotyped 31 top surface.
In order to adapt to the application the preceding of fixed flat planar assembly 30, dull and stereotyped crooked on two degree of freedom.Specifically, dull and stereotyped basal surface 42 can be along long radius R bending, and the center of this long radius R is comprising on the vertebral plane of axis L, as shown in figure 16, so that adapt to the lordotic curve of cervical spine.In addition, basal surface 42 forms an intermediary/lateral curvature C, as shown in figure 18, so that basivertebral curvature correspondence.Should be understood that dull and stereotyped 31 is also flexible when needs adapt to concrete anatomy of spine and vertebra pathological changes.
Referring now to Figure 19 a,, it is the partial sectional view of fixed flat planar assembly 30, and wherein, the hole is installed with the screw 50 that meshes with vertebrae V 1 for 34 li, and keeps assembly 33 in latched position.Pair of screws 50 is placed on 34 li in each hole, and threaded rod 51 is given prominence to and entered the vertebral body V1 from dull and stereotyped 31 lower surface 42.The mid portion 52 of screw 50 extends by the cylindrical hole 77 in 34 li in hole.When screw 50 was positioned at wherein, the spherical surface 57 of head 54 contacted with the recess 45 in hole 34.Mid portion 52 provides to the screw 50 77 li of cylindrical holes and is slidingly matched, and screw 50 can not dull and stereotyped 31 be pivoted relatively.
Referring to Figure 19 b, it is the partial sectional view of fixed flat planar assembly 30, and wherein, elongated hole 32 or 35 li are installed with the screw 50 with vertebrae V 1 engagement, and keep assembly 33 to be positioned at latched position.Pair of screws 50 is placed on each elongated hole 32 and 35 li, lower surface 42 outstanding enter corresponding vertebral body V2, V3 or V4 in of threaded rod 51 from dull and stereotyped 31.The cylindrical part 52 of screw 50 extends through the slotted eye 78 of elongated hole 35 and 32 and 79 li respectively.When screw 50 was positioned at wherein, the spherical surface 57 of head 54 and elongated hole 32 contacted with 47 with 35 recess 46.Cylindrical part 52 provides for the screw slotted eye 78 and 79 li and is slidingly matched, and screw 50 can not be pivoted relative to dull and stereotyped 31 axis 72c or move.Certainly, the screw 50 that inserts elongated hole 32 or 35 li can move along the length of elongated hole 32 and 35 as mentioned above.Should be understood that the present invention also expects many embodiment of dull and stereotyped 31, their use the screw of variable-angle, and this screw is in relative dull and stereotyped 31 the various angular orientation with 35 and the 34 li energy in hole of elongated hole 32.
Remain on dull and stereotyped 31 li in order to ensure screw 50, keep assembly 33 to be moved to its latched position, there, it contacts with the head 54 of 34 li in the hole bone screw 50.70 li in the screw threads for fastening hole of lock screw 85 screw-ins dull and stereotyped 31 is moved pad 90 as mentioned above to latched position from unlocked position, cause contact surface 106 to contact with the inclined surface 58 of screw 50, shown in Figure 19 a.Contact surface 106 preferably applies a downward power on head 54, makes screw head steadily be positioned at dull and stereotyped recess component, and further screw 50 is fixed on 34 li in hole.In a preferred embodiment, when surface 106 contacted with inclined surface 58, this downward power was that pad 90 applies.Shown in Figure 19 b, the outer surface 104 of pad 90 does not contact with head at the bone screw 50 of elongated hole 32 and 35 power.Outer surface 104 overlaps on the bone screw 50, and bone screw is remained on elongated hole 32 and 35 li.If bone screw withdraws from from elongated hole 32 and 35 li, outer surface 104 will contact with the head of bone screw.Preferably, the basal surface 100b of pad 90 does not contact with the basal surface 73 of groove 39.
According to another aspect of the present invention, keep assembly 33 can be fixed on dull and stereotyped 31 with loosening, like this, in surgical procedures, the surgeon need not fiddle with on dull and stereotyped 31 and keep assembly 33.Lock fastener 85 is inserted 91 li of the apertures of pad 90 in advance, and partly screws in 70 li of fastener holes.Pad 90 initial positions make second end of each aperture 91 be positioned at lock screw 85 near.Behind screw 50 hole and elongated hole on by dull and stereotyped 31, lock fastener 85 further enters 70 li in hole, and the tapering part 92 of aperture 91 makes pad 90 move to latched position, and bone screw 50 is remained on dull and stereotyped 31 li.
As mentioned above, the sharp point 88 of lock screw 85 preferably can penetrate cortical bone.In an embodiment, when dull and stereotyped 31 are placed on the bone at first, sharp point 88 will penetrate vertebra.In this example, lock screw 85 helps when bone screw 50 meshes with vertebra flat board to be located and is stabilized on the vertebra temporarily.This interim location that provides by lock screw 85 also can be used for keeping dull and stereotyped 31 positions on vertebra when accepting bone screw 50 using drill guide device boring and tap vertebra.
According to another aspect of the present invention, provide a kind of and be fixed on the vertebra of spine portion and apply a compressive load to being placed on the graft in the spine portion or the apparatus and the technology of implant with dull and stereotyped 31.Referring to Figure 20 (a)-20 (f), guide 150 comprises one handle 152, a template 154 and the arm 153 that extends between them.Preferably, arm 153 stretches out and is bent from spinal column, makes handle 152 be parallel to spinal column, makes handle not become surgical obstacle.Template 154 comprises second end 155 that is formed with a recess 158.Template 154 also comprises first end 156, thereby it has the outstanding 156a that extends to vertebral body V2 downwards.Template 154 also forms a pair of elongated hole 157 between second end 159 and first end 156.
The surgeon selects a guide 150, and wherein the size of template 154 should make recess 158 be positioned on the ideal position of vertebrae V 2, then guide 150 is placed on the vertebral body V2.By giving prominence to the soleplate adjacent contact that 156a is placed to vertebrae V 2 in the D of plate-like space recess 158 is positioned on the vertebrae V 2.Elongated hole 157 provides the indication directly perceived of the scope of the basivertebral position of elongated hole 35 insertions that allows screw pass through flat board 31 to the surgeon.If desired, the surgeon can obtain ideal position or the zone and the ideal useful scope of bone screw on vertebrae V 2 of recess 158 by the template 154 of selecting to have different size.
Referring now to Figure 20 (b),, be positioned on the ideal position of vertebrae V 2 at recess after, by the guiding of recess 158, a compression pin 170 is put into 2 li of vertebrae V.Pin 170 comprises that one has the lower end 171 of threaded portion (not shown), so that pin 170 is fixed on the vertebrae V 2.Standing part preferably has screw thread, so that screw in 2 li of vertebrae V, but also has most advanced and sophisticated shiny surface, so that insert vertebra.Pin 170 also comprises tool engagement part 172, so that pin 170 is installed on the vertebral body.Also imagine in addition, reach vertebral tissue if desired and allow, the surgeon may be placed on pin 170 on the vertebral body that leaves recess 158.
After pin 170 and vertebrae V 2 mesh, unload guide 150, with a sleeve pipe 180 parcel pins 170, shown in Figure 20 (c).Sleeve pipe 180 has hollow body 181, and this hollow body extends between near first end 186 of vertebrae V 2 and second end 184.Second end 174 of pin 170 preferably extends from second end 184 of sleeve pipe 180, thereby allows near pin 170.Sleeve pipe 180 comprises amplifier section 184, so that be provided with and take away sleeve pipe 180.Also imagine, sleeve pipe 180 has hollow inner side and inboard configuration, so that provide safe fixing to pin.Body 181 comprises the cylindrical outer surface 182 with d6 external diameter.
When sleeve pipe 180 is positioned at the appropriate location, place flat board 31, make outer surface 182 adjacent contact of recess 40 and sleeve pipe 180, shown in Figure 20 (d).The outside diameter d 6 of sleeve pipe 180 is slightly less than the twice of recess 40 radiuses, makes recess 40 around sleeve pipe 180.Then, by in the hole 34 li insert screws 50 and flat board 31 be fixed on the vertebrae V 1.
Because dull and stereotyped 31 have been fixed on the vertebrae V 1, take sleeve pipe 180 away from pin 170, shown in Figure 20 (e), thereby between pin 170 and recess 40, form gap 177.In a preferred embodiment, expection gap 177 is 2mm approximately.Yet according to the ideal compression that is applied in, gap 177 also can be other size.
Referring now to Figure 20 (f),, a tool of compression 290 is fixed on the pin 170 and 32 li of dull and stereotyped 31 elongated hole.Also expection can be fixed on the flat board 31 by (for example) and dull and stereotyped 31 side engagement tool of compression rather than 32 li of elongated hole.Tool of compression 290 has the first arm 291, and it has first footing 294 that connects pin 170.Second arm 292 is connected with second end of elongated hole 32 by the extension 297 of extending from second footing 296.The first arm 291 and second arm 292 apply a compressive load by surgical skilled operation and give spine portion.The amount that applies load is limited by the gap 177 between pin 170 and recess 40.For example, be that spine portion is compressed 2mm in the specific embodiment of 2mm in gap 177.
Bone screw 50 is inserted 35 li of elongated hole, and tool of compression 290 is still kept compressive load.Because the inclined-plane 60 at elongated hole 35 second ends 43 places is along with screw inserts 35 li of elongated hole as mentioned above and obtains an extra dynamic compression amount.Because screw 50 is positioned at second end, 43 places of elongated hole 35, can takes tool of compression 290 away and do not remove compressive load.Other bone screw can insert 32 li in intermediate elongated hole.Then, can mobile as described above pad, so that bone screw is remained on dull and stereotyped 31 li.Should be understood that and expect also that here tool of compression 290 and pin 170 are preferably only with providing the flat board of apparatus to use on three or polylith vertebra.Yet, do not get rid of use its shape can with the tool of compression of the flat board engagement that apparatus is provided on two vertebras.
Referring now to Figure 21 (a)-21 (c),, they provide other details of tool of compression.Instrument 290 has the first arm 291, and it has first footing 294 that extends from it.Be formed with recess 293 on first footing 294, so that admit pin 170.Second arm 292 has second footing 296 that extends from it.Second footing 296 comprises the extension 297 of extending from it downwards, and its shape can mesh with dull and stereotyped 31 intermediate elongated hole 32.Extension 297 preferably comprises recess 307, its shape can with second end in contact in intermediate elongated hole 32.Expect that also extension 297 has a curved bottom surface 308, it is corresponding with basivertebral medial side face curvature.
The first arm 291 has a thickness and reduces part 309, and it extends through the passage 295 that is formed on second arm 292, and by pin 299 pivotable being connected on second arm 292.The first arm 291 has crooked handle portion 306, and it has outstanding 303 of extension from it.Second arm 292 has handle 305.One ratchet bar 301 is connected with second arm 292 pivotly by adapter 302.Preferably, ratchet bar 301 is resiliently biased towards outstanding 303.Be formed at serration 304 on ratchet bar 301 bottom surfaces provide with the first arm 291 on outstanding 303 selectively engagements.
The first arm is compressed by relative with second arm, so that partly apply compressive load for vertebra.Outstanding 303 contacts with the zigzag bottom surface of ratchet bar 301, prevent that arm from relaxing in bone screw 50 insertion elongated hole 35 processes, so that keep this compressive load.Ratchet bar 301 can resist fexible bias pressure and leave arm 291 and rise, so that ratchet bar 301 was opened with outstanding 303 minutes.Then, arm 291 can be relative to separately moving, so that take tool of compression 290 away from pin 170 and dull and stereotyped 31 with 292.
Though described tool of compression 290 in detail, the present invention also expects has other instrument can be fixed between pin 170 and dull and stereotyped 31, so that provide compressive load to spine portion.For example,, imagine the first arm 391 and second arm 392 that a tool of compression can comprise that one or more angles change, so that at surgical site approaching dull and stereotyped 31 and pin 170 referring to Figure 22 (a) and 22 (b).The first arm 391 has bottom 391a, its relative first footing, 396 angulation B1.First footing 396 has the extension 397 of extension 297 that extend, that be similar to instrument 290 from it.The first arm has top 391c, and its end is a curved handle 406.Curved handle 406 has from it extend outstanding 403, so as with the ratchet bar engagement of extending from second arm 392.Arm 391 has the vertical stretch that extends and divides 391b between bottom 391a and top 391c.Between bottom 391a and vertical component 391b, form included angle B 2.Between vertical component 391b and top 391c, form included angle B 1.Vertical component 391b has a thickness and reduces part 399, so that be connected with second arm 392.
Second arm 392 has bottom 392a, and it and second footing 394 form included angle B 1.Second footing has the recess (not shown) of admitting pin 170, and the recess 293 that this recess and above-mentioned instrument are 290 li is similar.Second arm 392 has top 392c, and its end is a handle 405.Top 392c has the ratchet bar 401 of band saw dentation 404.Ratchet bar 401 is connected on the arm 392 pivotly, and resiliently biased towards outstanding 403.Ratchet bar 401 is similar to ratchet bar 301, but preferably is bent along its length, so that hold angular deflection when the engagement of keeping between ratchet bar 401 and outstanding 403.Arm 392 has a vertical stretch that extends and divides 392b between bottom 392a and top 392c.Between bottom 392a and vertical component 392b, form included angle B 2.Between vertical component 392b and top 392c, form included angle B 1.Vertical component 392b has a slot 395, so that admit the thickness of vertical component 391b to reduce part 399, the first arm is connected by the pin (not shown) there pivotly with second arm.
In a specific embodiment of tool of compression 290 and 390, included angle B 1 is 120 degree approximately, and included angle B 2 is 150 degree approximately.Yet for those skilled in the art, other angular deflection of the first arm in the tool of compression 190 and 290 and second arm also is expected.
Though in accompanying drawing and above-mentioned explanation, described the present invention in detail; yet it is descriptive and nonrestrictive that above-mentioned content is considered to, and will be appreciated that; only show and described preferred embodiment, and all changes in spirit of the present invention and improve and all wish and can be protected.

Claims (12)

1. bone fixation systems for the part usefulness of spinal column comprises:
One flat board, it has along the length of a central axis of longitudinal extension between first end and second end, and along a top surface and a basal surface of described length, described flat board also has a plurality of first perforates and a plurality of second perforate between described two surfaces, wherein:
At least two of described first perforate is circular, has first diameter, and is positioned near described first end;
At least two of described second perforate is elongated, has first width and first length, and is positioned near described second end of described flat board;
Fastening element for osteosynthesis, they extend through described first and second perforates, a screwed elongated stem and an enlarged head portion above each fastening element for osteosynthesis has one, described fastening element for osteosynthesis can insert described first and second perforates from described top surface; And
The described head of described fastening element for osteosynthesis is remained on device in described first and second perforates, described holding device can move to the second position that described fastening element for osteosynthesis is remained in described first and second perforates from the primary importance that allows fastening element for osteosynthesis to insert described first and second perforates, and described holding device comprises:
Be formed on the described flat board, near first fastener hole described two first perforates, and be formed on the described flat board, near second fastener hole described two second perforates;
One pad, has a body, at least have on the body near first aperture described two first perforates and near second aperture described two second perforates, and the counterbore part that is communicated with described each aperture, described aperture respectively forms an elongated hole, this elongated hole has the length along dull and stereotyped longitudinal extension, and described pad also has the surface that contacts with the described head of the described fastening element for osteosynthesis that extends through described two first perforates and/or described two second perforates; And
For the lock fastener that described each aperture uses, it has the head of the described counterbore part that can partly enter described pad at least, and the elongated shaft that extends through the described fastener hole engagement of described aperture and described flat board.
2. bone fixation systems as claimed in claim 1 is characterized in that, described two first perforates have near the recess described top surface, and described two second perforates have near the recess described top surface.
3. bone fixation systems as claimed in claim 2 is characterized in that, described head to the small part of described fastening element for osteosynthesis enters in described two first and second perforates.
4. bone fixation systems as claimed in claim 1, it is characterized in that, described two first and second perforates respectively are included near the recess the described top surface, and described enlarged head portion has the complementary partial spherical surfaces of described recess with described two first and second perforates.
5. bone fixation systems as claimed in claim 4 is characterized in that, described flat board also is included on the described top surface, along described dull and stereotyped longitudinal extension so that admit the groove of described holding device, described holding device and described recess are overlapped.
6. bone fixation systems as claimed in claim 1, it is characterized in that, the described head of described fastening element for osteosynthesis has inclined surface, and described holding device has the contact surface that contacts with the described inclined surface of the described fastening element for osteosynthesis that extends through described two first perforates.
7. bone fixation systems as claimed in claim 6 is characterized in that, the counterbore part of at least one described aperture is taper along the described length of described elongated hole, and has the width that increases to described first end from described second end along the length of described aperture.
8. bone fixation systems as claimed in claim 6 is characterized in that, described at least one aperture is positioned near described two second perforates.
9. bone fixation systems as claimed in claim 1 is characterized in that, also comprises the implant that is positioned in the spinal column.
10. one for the elongated dull and stereotyped securing member maintenance assembly that uses, described flat board has the length of extending between at least two vertebras, described flat board is formed with for fastening element for osteosynthesis and inserts so that flat board is fixed on perforate at least two vertebras, and described maintenance assembly comprises:
Be formed on the described flat board, near first fastener hole at least one perforate that is positioned at above first vertebra, and be formed on the described flat board, near second fastener hole at least one perforate that is positioned at above second vertebra;
One pad, at least near at least one the described perforate that is positioned at above first vertebra, be formed with first aperture, near at least one the described perforate that is positioned at above second vertebra, be formed with second aperture, described aperture respectively forms an elongated hole, this elongated hole has the length of extending along dull and stereotyped length direction, described pad also have with extend through described flat board in the surface that contacts of the head of described fastening element for osteosynthesis of described perforate, in order to described fastening element for osteosynthesis is remained in the described flat board; And
Lock fastener for described each aperture use, described lock fastener have extend through described aperture, with described flat board on the elongated shaft of described fastener hole engagement, described pad can remain on the fastening element for osteosynthesis of described insertion between the second position in the described flat board and move allowing described fastening element for osteosynthesis to insert the primary importance of described at least one perforate and pad.
11. maintenance assembly as claimed in claim 10 is characterized in that, described each aperture has the counterbore part that is communicated with described elongated hole.
12. maintenance assembly as claimed in claim 11 is characterized in that, the described countersink region of described at least one aperture is divided tapered, and the width that has length along described aperture, increases gradually to first end from second end.
CNB2004100033213A 1999-10-13 2000-10-11 Fastener holding assembly and anterior cervical plating system having same Expired - Fee Related CN1250172C (en)

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US09/417,402 US6533786B1 (en) 1999-10-13 1999-10-13 Anterior cervical plating system

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